Irregular and heavy menses? The suspect: PMOS

For many women, the signs develop gradually. A cycle that was once predictable may become irregular, with periods occurring infrequently, lasting for extended periods, or causing excessive bleeding. Some women may go three to six months without menstruating, while others struggle with recurring symptoms that seem difficult to explain. Understanding why these changes occur is the first step toward recognizing PMOS, seeking appropriate care, and preventing potential long-term complications.

What exactly is Polyendocrine Metabolic Ovarian Syndrome?

Polyendocrine Metabolic Ovarian Syndrome (PMOS), formerly called Polycystic Ovarian Syndrome (PCOS), is a metabolic and hormonal disorder affecting women all over the world, affecting 8-13 out of every 100 women of reproductive age. It may affect fertility, menstrual cycles, skin, self-esteem, and mental health. It was initially known as Polycystic Ovarian Syndrome, but its nomenclature was changed after it was noted that not all women with PMOS have ovarian cysts.

Simply put, it is a condition in which the body, particularly the ovaries, produces large amounts of male hormones called androgens, leading to other cascades of hormone dysregulations. In a normal female body, there is a low amount of androgen, but this amount is significantly lower than the amount in the males. When the level of androgen in the female body rises above the normal threshold required, it affects the process of ovulation, which is a monthly activity of the ovaries leading to the release of eggs from the ovaries into the fallopian tubes.

“Your period is more than a monthly event, it’s one of your body’s most important health signals.”

Common symptoms and their explanations:

1. 1
   Irregular menses:

   Note that regular ovulation and regulation of hormones like estrogen, luteinizing hormone(LH), follicle stimulating hormone(FSH) and the others are needed for menstrual cycle to occur effectively. With hormonal dysregulation, which is the baseline of the pathology behind PMOS, ovulation would be unlikely to happen, leading to menstrual dysregulation. Your body may show signs of these menstrual dysregulations in various ways, either by: I. Being less than normal II. Being unpredictable; more like showing up unannounced III. Stopping entirely IV. Being unusually heavier than your normal periods. Most times, irregular periods are the first warning sign to PMOS
2. 2
   Unexplained excessive weight gain:

   PCOS is a metabolic and hormonal condition, and insulin plays a major role in this symptom. There is insulin resistance, and the body no longer responds properly to insulin. This causes the body to produce higher levels of insulin. Insulin also causes the body to store fats, especially around the abdomen. Excess weight gain worsens hormonal imbalances by acting on the ovaries, thereby creating a vicious cycle that is difficult to break.
3. 3
   Facial hairs and body hair growth:

   Remember androgen? The male hormone that is increased in the female body in PMOS, is normally high in men and is responsible for the male changes during puberty, which include growth of mustache, facial and chest hairs, deepening of voices, and the male physique. When it becomes high in women, it leads to facial hair and also growth of hair in areas where women wouldn’t naturally develop hair.
4. 4
   Acne:

   Androgens stimulate oil glands to produce more oils in the face. When in excess, oils can clog the pores and encourage growth of Cutibacterium acnes, a bacterium that contributes to acne formation, thereby causing acne in these women.
5. 5
   Infertility:

   Irregular or absent ovulation may make conception more difficult, making PCOS one of the common causes of female infertility. However, many women with PCOS can conceive naturally or with treatment. Please note that this list is not exhaustive and symptoms may vary from one woman to another; they can be severe in one and mild in another.

How can the diagnosis of this condition be made?

If you experience any of these symptoms, it’s only right for you to visit your healthcare professional, preferably a gynecologist, to review your symptoms. Diagnosis can be made based on your medical history and physical examination, ultrasound findings, and biochemical tests.

Can this condition be treated?

Treatment of PMOS is posing a great challenge to healthcare as there are multiple contributing factors affecting the condition. However, symptomatic treatments have proven to be successful.

Treatment options include:

I. Lifestyle modification, which includes regular exercise, healthy eating, and adequate weight management

II. Use of contraceptives to regulate menstrual cycles

III. Use of ovulation induction agents to encourage ovulation

IV. Medical treatment for excessive hair growth and acne

V. Management of insulin resistance

VI. Laparoscopic ovarian drilling may be an option for women desirous of fertility who do not respond to medical ovulation induction.

The management of PMOS is individualized and depends on the woman’s symptoms, fertility goals, and personal preferences.

When to see a doctor?

As soon as you notice a change in your menstrual cycle, absent menses for three consecutive months, presence of any of the above symptoms, or when due for a follow-up even after diagnosis.

Possible health Complications of PMOS:

PMOS is not just a condition that affects periods and fertility. Over time, it can increase the risk of other health problems, especially if it is not properly managed. The following are some of the possible long-term complications of PMOS:

1. Dyslipidemia

2. Prediabetes

3. Type 2 diabetes mellitus

4. Hypertension

5. Cardiovascular disease

6. Endometrial hyperplasia

7. Obstructive sleep apnea

8. Anxiety and depression

In summary, being diagnosed with PMOS can be overwhelming to the woman and may pose a challenge to the doctor. However, with proper understanding of what the condition is all about and compliance with lifestyle modifications, medications, and follow-up visits, women living with PMOS can lead healthy, productive, and fulfilling lives with appropriate treatment and follow-up.